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Pattelo-Femoral Joint Dysfunction PowerPoint Presentation

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This medical PowerPoint presentation is about patellofemoral joint dysfunction (PFJD), also known as patellofemoral pain syndrome (PFPS). Patellofemoral joint dysfunction is a common knee problem characterized by pain around the patella (kneecap) and the surrounding areas. PFJD can occur due to a variety of reasons, including overuse, muscular imbalances, or abnormalities in the alignment or structure of the knee joint.

The symptoms of PFJD typically include pain and discomfort around the front of the knee, especially when performing activities that involve bending the knee, such as climbing stairs, squatting, or running. In some cases, there may also be a sensation of grinding or popping in the knee joint.

Treatment for PFJD may include a combination of physical therapy, exercises to strengthen the muscles around the knee, and modifications to the patients activity level or footwear. In some cases, orthotics or braces may also be recommended. Surgery is typically only considered in severe cases where conservative treatment methods have failed to provide relief. It is important to consult with a healthcare professional to determine the best course of treatment for individual cases of PFJD.

Tags : Pattelo-femoral joint dysfunction, patellofemoral pain syndrome, knee problem, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 944 | Downloads : 3

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Slide 1-

Pattelo-femoral joint dysfunction A biomechanical approach to assessment, diagnosis treatment and prevention
Slide 2-

Sports Physiotherapist specialising in swimming Founder and practice principal physiotherapist, Newcastle Physiotherapy Former Senior GB International swimmer and British record holder for 200 and 400 I.M Member of the GB Swimming Physiotherapy team, London 2012 Olympic Games Darren Wigg, Bsc (Hons) MCSPSM, HCPC Reg. Introduction
Slide 3-

What is patellofemoral joint dysfunction? As the name infers, patellofemoral dysfunction is an injury that occurs at the articulation between the patella (kneecap) and the underlying femur. Anatomically, the patella is a diamond-shaped bone which lies in a correspondingly shaped groove in the front of the femur. It is designed to function as a pulley, assisting the quadriceps by providing a mechanical advantage for added strength. Generally speaking, patellofemoral dysfunction occurs under one of two broad circumstances -- either when the patella is forced with excessive pressure against the underlying femur or when it tracks excessively on one side or other of the groove. In either case, this would cause irritation and abrasion of the cartilage of the patella, resulting in inflammation and pain. Umbrella term used for pain arising patello-femoral joint Also known as anterior knee pain Often insidious onset but can be traumatic Extremely common in runners and sports involving running, jumping and kicking
Slide 4-

Boney Anatomy Saddel joint Patella and Femur Controlled by quads -extensor mechanism Tracking aided by concave patellofemoral groove Convex patella
Slide 5-

Soft tissues influencing PFJ Quadriceps Quads tendon Patella tendon Patella retinaculum Not this simple.......
Slide 6-

Soft tissues influencing PFJ Gluteals Illiacus and Psoas Hamstrings Gastrocnemius Tensor fascia lata Illiotibial band Adductors
Slide 7-

Common subjective findings Usually intermittent pain located around/under pattella Insideous onset more common Aggravating activities: running, prolonged walking, ascending and decsending stairs, squatting, prolonged sitting, wearing unsupportive footwear (flip flops!) Easing activities: avoidence of aggs, ice, NSAIDS Activity dependent diurnal pattern Special Q’s: No true locking No true giving way No 'cluncking' but may report clicking
Slide 8-

Athletes.....all about the detail Training errors and what has changed? - increase in volume - increase in intensity - change of terrain - change of footwear - change of technique - change of coach - injury prevention strategies Past injury history -compensation for other injuries? You should be 95% sure of diagnosis following a good subjective!
Slide 9-

Common objective tests/findings Confirmation of provisional diagnosis! No joint effusion Pain on single leg squat Pain on full squat Critial test positive Patello-femoral joint compression positive Hypomobile PFJ Postural imbalances............. Note: always clear meniscal and ligamentous stress tests first! Not uncommon for PFJ dysfunction to be a secondary problem
Slide 10-

Common objective findings Hip/pelvic postural variation Deficiencies in length and / or strength in any of the muscle groups that can act upon the PFJ Foot biomechanics
Slide 11-

Common postural findings Click to add text Asymmetries Boney land marks Acromion Spine - Illiac crests - PSIS - ASIS - Greater trochanter - Base/pole patella/post knee creases - Tibial tuberosity - Malleoli - Medial arch Valgus or varus presentation........
Slide 12-

Thomas Test Provides lots of biomechanical information Hip flexor length Quads length Adductor length Anteriolateral chain
Slide 13-

Thomas test Increase hip extension by 1 degree = 2% increase in stride length Performance enhancement Injury prevention
Slide 14-

Obers test Length test of: - Tensor fascia lata - ITB - General anterolateral chain Positive test - reproduction of pain - reduced range in comparison to asymptomatic side/knee unable to rest on bed
Slide 15-

Single leg squat test Hip and pelvis control knee control/position Forefoot pronation/supination Balance Signs of fatigue Pain Observe running if possible
Slide 16-

PFJ stress tests Lateral glide Medial glide Cephalad glide Caudad glide Compression Pain Restriction
Slide 17-

Critical Test Preferable in supine Resisted knee extension throughout full range Posiitve with reproduction of pain +/- weakness
Slide 18-

Common diagnosis PFJ maltracking causing retropatella pain/infrapatella fat pad inflammation (biomechanical +/- training error) ITB friction syndrome (biomechanical +/- training error) *Patella tendon tendinopathies or calcification (biomechanical +/- training error) *Chondromalacia patellae (genetic) *PFJ OA (genetic or post trauma) *Referred pain from lumbar spine Diagnosis is relatively easy – underlying cause is fundamental for successful treatment outcomes
Slide 19-

Typical problem list Training load errors Poor injury prevention program/strategies Biomechanical deficiencies such as: Valgus knee posture Weak medial quads/underactive glutes Tight hip flexors/quads/ITB Forefoot pronator with inappropriate footwear
Slide 20-

Typical treatment plan Advice and education surrounding acute pain management and adaptation of training PFJ taping (Kinesio tape or McConell) Manual therapy: PFJ/SIJ/Lumbar spine mobilisation Specific soft tissue mobilisation ( commonly QL, glutes, TFL, ITB, biceps femoris, gastrocnemius) PNF Exercise therapy: - Progressive strength, stability, proprioceptive program for weak/underactive muscle groups focussing on lumbopelvic, hip and knee region - Stretching and foam roller program for hypertonic/overactive/short muscle groups Anti-pronation taping followed by orthotic fitting
Slide 21-

Key points to take away Common sports injury Diagnosis should be easy Thorough subjective assessment important Knowledge and understanding of athletic training/overload principles, biomechanics and muscle imbalance is fundamental for successful outcomes Expert manual and exercise therapy skills fundamental for successful outcome Don’t forget your injury prevention program!!!